Monitoring
The frequency and specifics of patient follow-up depend on the type and severity of the clinical manifestations, and the need to monitor for medication side effects.
Yearly pulmonary function tests (with spirometry, lung volumes, and diffusion capacity) and echocardiography should be done for surveillance in all patients with mixed connective tissue disease (MCTD), to identify and assess for the development of pulmonary hypertension.
Serological tests are not generally used to monitor disease activity in MCTD. However, they may be of value in the following circumstances:
In patients who have anti-double-stranded DNA titres, increasing titres may herald a disease flare.[56]
In patients with antisynthetase antibodies, titres may fluctuate during the course of the disease; their disappearance suggests a good prognosis.
Monitoring for corticosteroid treatment side effects
Assess the patient’s risk of corticosteroid-induced osteoporosis, and commence prophylactic treatment as required. See Osteoporosis (Management approach).
Initial fasting blood glucose and regular blood glucose levels are recommended in chronic corticosteroid treatment.
H2 antagonists or proton pump inhibitors may be prescribed if the patient develops gastrointestinal discomfort or has a history of peptic ulcer disease.
BP is measured on each visit, as accelerated hypertension and renal failure could occur, particularly in patients with scleroderma or MCTD and overlap syndrome.
Eye examinations are performed periodically to check for cataracts and glaucoma.
Serum potassium levels are monitored. Potassium supplementation may be required if the patient becomes hypokalaemic.
Monitoring for immunosuppressant treatment side effects
Methotrexate: FBC, serum creatinine and LFTs including gamma-GT are checked every 1 to 2 weeks until the dose is stable, then every 8 to 12 weeks.
Azathioprine: FBC and LFTs including gamma-GT are checked every 1 to 2 weeks until the dose is stable, then every 8 to 12 weeks.
Hydroxychloroquine: ophthalmological evaluation for the development of retinopathy should be done at a frequency consistent with local practice.
Intravenous immunoglobulin (IVIG): Measurement of baseline renal function is recommended because of risk of IVIG-induced renal failure. Serum immunoglobulin (IgA) levels should be checked prior to first administration as anaphylaxis may occur in IgA deficient patients.
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